1. What you thought you knew about European Union social policy is now wrong: Social Policy and Economic Governance since 2010 Scott L. Greer University of Michigan slgreer@umich.edu

2. Co-author  Holly Jarman, PhD  Department of Health Management and Policy  University of Michigan School of Public Health  hjarman@umich.edu

3. The third face of the EU  EU as regulatory market state  EU as health policy maker  and EU as economic government

4. 1. The EU as a market-making regulatory state  Regulatory nature of EU  Tiny budget, weak staff resources...  Powerful ability to co-opt experts  Powerful legal system  Result: EU creates obligations & others pay  "Constitutional" objectives of EU law: Freedom of movement of goods, services, capital and people (“four freedoms”)

5. 2. The EU as economic governance  Major changes in nature and powers of the EU since 2010  Economic adjustment programmes: Greece, Portugal, Ireland, Cyprus.  ECB as active proponent of microeconomic reform (!)  Treaty changes: judicialise and harden SGP fiscal targets (3% deficit, 60% debt, 1.4% public sector spending growth). EU institutions define and enforce.  Obligatory constitutional changes (schuldenbremsen)  European Semester: coordinate budgets & policies  Strength and hierarchy are in economic, not social policy

6. 2. Consequences for health  Health and social objectives are almost irrelevant  EAPs lack health impact assessment; bad effects  Objectives of European semester, Macroeconomic Imbalances Procedure, SGP... exclude health  But social and health advocates can participate in procedures (especially European Semester) that state goals and make trade offs in country-Commission talks

7. 3. EU as social policy maker: public health examples  Legacy of Maastricht & subsequent treaty changes: specific policies justified as public health  Many areas where health joins other powers to produce public health policy  Food safety, tobacco control  Or health as countervailing power  Food/agriculture policy, patient mobility

8. Challenges  Framing: making food, or security, or trade, or economic governance a health policy and not just a policy affecting health. A legal and political task made easier by Maastricht and successor treaty revisions.  Taming economic governance: participating in European Semester, National plans. Lobby and provide evidence on importance of health at EU and state level. Otherwise we lose what we have gained since Maastricht.  Use legal instability: EU law begets integration begets legal challenge begets law. Know it and use it.  Think bigger. Another EU is possible and desirable.

9. References  McKee & Mackenbach, “Health in Europe” Lancet series: http://www.thelancet.com/series/health-in- europehttp://www.thelancet.com/series/health-in- europe  Greer & Kurzer, eds. European Union Public Health Policies. Routledge, 2013.  Greer, "Avoiding Another Directive" Health Economics, Policy and Law, forthcoming: http://journals.cambridge.org/abstract_S1744133112000 424 http://journals.cambridge.org/abstract_S1744133112000 424  On economic governance: http://www.ose.be/EN/publications/ose_paper_series. htm (www.ose.be more generally) http://www.ose.be/EN/publications/ose_paper_series. htmwww.ose.be

10. Thank you  Scott L. Greer, University of Michigan  slgreer@umich.edu slgreer@umich.edu